There are fewer people to cover for you when working in a private practice, Dr. Holland said. “It’s very difficult to get coverage; it’s almost unheard of,” he said. He worked at a private practice for 18 years and became an employee in March 2021.
Explore This IssueOctober 2023
When he feels ill, Dr. Holland checks his temperature and assesses whether what he has is contagious. Like lay people, he believes that physicians take over-thecounter medications to treat their ailments and try to feel as good as possible. “But you have to be sure that any medication you take doesn’t interfere with your decisionmaking process,” he said.
Dr. Holland is motivated to go to work even when he doesn’t feel well because he envisions the workload that will pile up if he’s out for a few days. “It’s a highly motivating force,” he said. “I hate the thought of burdening my coworkers.”
Coping with Outages
The post-COVID workplace has seen extreme shortages of healthcare workers at all levels.
It’s not always helpful to ask physicians if they want to go home. They often reply “no,” not because they don’t want or need to, but because they can’t get themselves to say what they need. — Julie Wei, MD, MMM
“We’re stretched so thin as it is; there usually isn’t anyone to cover at any level,” Dr. Holland said. “Therefore, physicians are motivated to show up under minor debilitating conditions just to keep the system afloat.”
When nurses are out sick, Dr. Wei said that staff who are in the same or similar roles may be able to step in and provide coverage. For example, a nurse in one surgical subspecialty clinic may be able to cover for someone in another subspecialty clinic.
For nurses on the inpatient unit, instead of having one nurse cover three patients, the ratio may increase to four, five, or even more patients assigned to one nurse. Oftentimes, however, a charge nurse will get pulled to work temporarily as a bedside nurse.
If a supporting staff member who works in the operating room is absent, then someone else may be asked to volunteer to work on their day off, or staff may have to perform additional duties and cross-cover additional areas when possible, Dr. Wei said. If a clinic nurse is absent, however, most likely there will be more stress and chaos in the clinic flow, and voicemail messages from patients and colleagues may not be answered until the next day.
When surgical technicians call in sick, cases may have to be delayed or cancelled unless someone else who is trained and comfortable supporting those types of subspecialty cases is available, Dr. Wei said.
In private practices, cross training is critical to good coverage when someone is sick, Dr. McElveen said. If a midlevel provider is ill, other members of the clinic may need to step in. In addition, a surgeon may need to take on more responsibility in the administrative aspects of patient care, such as filling prescriptions.
What You Can Do When You Can’t Work
When a physician is ill and unable to work, they should report it to their designated leader as soon as possible. When Dr. Wei was a division chief, she worked closely with the operations manager to review all the templates of other team members and create the best strategies to minimize the need to reschedule or cancel patient appointments.
Dr. Wei will ask surgeons who are working that day if they’re able to add a few cases on to their schedules. “Some cases can’t be done by other surgeons and some families prefer not to change surgeons, so we need to consider all of that,” Dr. Wei said. “All changes and updates are provided to everyone on the team. All of this helps to achieve the goal of removing unnecessary and unconstructive guilt feelings.”
At times, Dr. Wei had to force physicians to leave work when they were dealing with grave personal issues. “It’s not always helpful to ask physicians if they want to go home,” she said. “They often reply ‘no,’ not because they don’t want or need to, but because they can’t get themselves to say what they need. Instead, I assess and make the choice for them and give them time and space.”
Added Dr. Wei, “It’s the duty of the ill physician to communicate early and often with their supervisor, provide updates, and express gratitude to other physicians who protect them and afford them the time off to recover.”
Sometimes a physician can’t help but miss work. “When I have an acute illness, I feel guilt and anxiety because patient appointments and procedures will have to be cancelled,” she said.
Dr. Wei also experiences angst because her partners and colleagues will have to cover her responsibilities, and she knows that she is creating more work for others.
When you do have to call in sick, Dr. Wei advised embracing the discomfort and practicing not feeling guilty. “Those feelings are temporary and are quickly gone after a few minutes, especially if physicians commit to an accurate narrative about themselves and their own wellbeing,” she said.